{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:39:08Z","timestamp":1790167148819,"version":"4.1.0"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T00:00:00Z","timestamp":1616112000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T00:00:00Z","timestamp":1616112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Rheumatol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The concept of mixed connective tissue disease (MCTD) as a unique connective tissue disease has endured for half a century. Disease onset can be in adulthood (MCTD) or of juvenile onset (jMCTD) and is characterized by overlapping features of systemic lupus erythematosus (SLE), polymyositis or dermatomyositis (PM\/DM) and systemic sclerosis (SSc). No universally accepted classification criteria for MCTD exists, however agreed upon overlapping disease features include the presence of high titers of U1 small nuclear ribonucleoprotein particle antibodies (U1snRNP) in the peripheral blood, Raynaud\u2019s phenomenon, synovitis, myositis and swollen hands or fingers. Characteristic capillaroscopy findings are commonly seen in MCTD and jMCTD, which may represent a crucial and key clue for classification as well as prognosis in these patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>We present a young male patient, with symptom onset as early as age 13, who was diagnosed with MCTD at age 16 and found to have high titers of anti-U1snRNP antibodies, Raynaud\u2019s phenomenon, synovitis, and swollen hands and fingers. Most interestingly, his video capillaroscopy at diagnosis was abnormal and revealed an active SSc-like pattern. His presentation and course are described.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We conclude that based on existing data, and as highlighted by this case presentation, nailfold video capillaroscopy should be included as an early screening tool for the detection of microangiopathy in patients with the diagnosis MCTD and jMCTD. Additionally, given its prevalence in this population at disease diagnosis, we recommend consideration be given to nailfold video capillaroscopy as a potentially important classification criteria and prognostic tool for jMCTD and MCTD.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s41927-021-00179-2","type":"journal-article","created":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T00:15:51Z","timestamp":1616112951000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Capillaroscopy as a diagnostic tool in the diagnosis of mixed connective tissue disease (MCTD): a case report"],"prefix":"10.1186","volume":"5","author":[{"given":"Mislav","family":"Radi\u0107","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3008-9432","authenticated-orcid":false,"given":"Rebecca S.","family":"Overbury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,19]]},"reference":[{"issue":"2","key":"179_CR1","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/0002-9343(72)90064-2","volume":"52","author":"GC Sharp","year":"1972","unstructured":"Sharp GC, Irvin WS, Tan EM, Gould RG, Holman HR. Mixed connective tissue disease--an apparently distinct rheumatic disease syndrome associated with a specific antibody to an extractable nuclear antigen (ENA). Am J Med. 1972;52(2):148\u201359.","journal-title":"Am J Med"},{"issue":"3","key":"179_CR2","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1001\/archpedi.1978.02120280047010","volume":"132","author":"A Fraga","year":"1978","unstructured":"Fraga A, Gudino J, Ramos-Niembro F, Aiarcon-Segovia D. Mixed connective tissue disease in childhood. Relationship Sjogren's syndrome. Am J Dis Child. 1978;132(3):263\u20135.","journal-title":"Am J Dis Child"},{"issue":"6","key":"179_CR3","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1016\/S0022-3476(77)80555-6","volume":"90","author":"BH Singsen","year":"1977","unstructured":"Singsen BH, Bernstein BH, Kornreich HK, King KK, Hanson V, Tan EM. Mixed connective tissue disease in childhood. A clinical and serologic survey. J Pediatr. 1977;90(6):893\u2013900.","journal-title":"J Pediatr"},{"issue":"5","key":"179_CR4","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1136\/ard.37.5.397","volume":"37","author":"RM Bennett","year":"1978","unstructured":"Bennett RM, O'Connell DJ. The arthritis of mixed connective tissue disease. Ann Rheum Dis. 1978;37(5):397\u2013403.","journal-title":"Ann Rheum Dis"},{"issue":"5","key":"179_CR5","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1002\/1529-0131(199905)42:5<899::AID-ANR8>3.0.CO;2-L","volume":"42","author":"MA Burdt","year":"1999","unstructured":"Burdt MA, Hoffman RW, Deutscher SL, Wang GS, Johnson JC, Sharp GC. Long-term outcome in mixed connective tissue disease: longitudinal clinical and serologic findings. Arthritis Rheum. 1999;42(5):899\u2013909.","journal-title":"Arthritis Rheum"},{"issue":"6","key":"179_CR6","first-page":"1088","volume":"23","author":"L Kotajima","year":"1996","unstructured":"Kotajima L, Aotsuka S, Sumiya M, Yokohari R, Tojo T, Kasukawa R. Clinical features of patients with juvenile onset mixed connective tissue disease: analysis of data collected in a nationwide collaborative study in Japan. J Rheumatol. 1996;23(6):1088\u201394.","journal-title":"J Rheumatol"},{"issue":"5","key":"179_CR7","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1007\/s11926-016-0576-x","volume":"18","author":"RA Berard","year":"2016","unstructured":"Berard RA, Laxer RM. Pediatric mixed connective tissue disease. Curr Rheumatol Rep. 2016;18(5):28.","journal-title":"Curr Rheumatol Rep"},{"issue":"3","key":"179_CR8","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1093\/rheumatology\/keu310","volume":"54","author":"ST Flam","year":"2015","unstructured":"Flam ST, Gunnarsson R, Garen T, Lie BA, Molberg O. The HLA profiles of mixed connective tissue disease differ distinctly from the profiles of clinically related connective tissue diseases. Rheumatology (Oxford). 2015;54(3):528\u201335.","journal-title":"Rheumatology (Oxford)"},{"issue":"5","key":"179_CR9","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1002\/art.1780330509","volume":"33","author":"RW Hoffman","year":"1990","unstructured":"Hoffman RW, Rettenmaier LJ, Takeda Y, Hewett JE, Pettersson I, Nyman U, et al. Human autoantibodies against the 70-kd polypeptide of U1 small nuclear RNP are associated with HLA-DR4 among connective tissue disease patients. Arthritis Rheum. 1990;33(5):666\u201373.","journal-title":"Arthritis Rheum"},{"issue":"1","key":"179_CR10","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1111\/tan.12698","volume":"87","author":"A Paradowska-Gorycka","year":"2016","unstructured":"Paradowska-Gorycka A, Stypinska B, Olesinska M, Felis-Giemza A, Manczak M, Czuszynska Z, et al. Association of HLA-DRB1 alleles with susceptibility to mixed connective tissue disease in polish patients. Hla. 2016;87(1):13\u20138.","journal-title":"Hla."},{"issue":"3","key":"179_CR11","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.rdc.2005.04.007","volume":"31","author":"M Aringer","year":"2005","unstructured":"Aringer M, Steiner G, Smolen JS. Does mixed connective tissue disease exist? Yes. Rheum Dis Clin North Am. 2005;31(3):411\u201320 v.","journal-title":"Rheum Dis Clin North Am"},{"issue":"3","key":"179_CR12","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.rdc.2005.04.009","volume":"31","author":"J Swanton","year":"2005","unstructured":"Swanton J, Isenberg D. Mixed connective tissue disease: still crazy after all these years. Rheum Dis Clin N Am. 2005;31(3):421\u201336 v.","journal-title":"Rheum Dis Clin N Am"},{"issue":"5","key":"179_CR13","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1002\/1529-0131(199805)41:5<768::AID-ART3>3.0.CO;2-Z","volume":"41","author":"JS Smolen","year":"1998","unstructured":"Smolen JS, Steiner G. Mixed connective tissue disease: to be or not to be? Arthritis Rheum. 1998;41(5):768\u201377.","journal-title":"Arthritis Rheum"},{"issue":"1","key":"179_CR14","doi-asserted-by":"publisher","first-page":"93","DOI":"10.3899\/jrheum.180019","volume":"46","author":"SO Hetlevik","year":"2019","unstructured":"Hetlevik SO, Flato B, Aalokken TM, Lund MB, Reiseter S, Mynarek GK, et al. Pulmonary manifestations and progression of lung disease in juvenile-onset mixed connective tissue disease. J Rheumatol. 2019;46(1):93\u2013100.","journal-title":"J Rheumatol"},{"issue":"2","key":"179_CR15","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/S0022-3476(06)80112-5","volume":"122","author":"HA Tiddens","year":"1993","unstructured":"Tiddens HA, van der Net JJ, de Graeff-Meeder ER, Fiselier TJ, de Rooij DJ, van Luijk WH, et al. Juvenile-onset mixed connective tissue disease: longitudinal follow-up. J Pediatr. 1993;122(2):191\u20137.","journal-title":"J Pediatr"},{"key":"179_CR16","first-page":"23","volume-title":"Mixed connective tissue disease and antinuclear antibodies","author":"GC Sharp","year":"1987","unstructured":"Sharp GC. Diagnostic criteria for classification of MCTD. In: Kasukawa R, Sharp GC, editors. Mixed connective tissue disease and antinuclear antibodies. Amsterdam: Elsevier; 1987. p. 23\u201332."},{"key":"179_CR17","first-page":"41","volume-title":"Mixed connective tissue disease and antinuclear antibodies","author":"R Kasukawa","year":"1987","unstructured":"Kasukawa R, Tojo T, Miyawaki S. Preliminary diagnostic criteria for classification of mixed connective tissue disease. In: Kasukawa R, Sharp GC, editors. Mixed connective tissue disease and antinuclear antibodies. Amsterdam: Elsevier; 1987. p. 41\u20137."},{"key":"179_CR18","first-page":"33","volume-title":"Mixed connective tissue disease and antinuclear antibodies","author":"D Alarcon-Segovia","year":"1987","unstructured":"Alarcon-Segovia D, Villareal M. Classification and diagnostic criteria for mixed connective tissue disease. In: Kasukawa R, Sharp GC, editors. Mixed connective tissue disease and antinuclear antibodies. Amsterdam: Elsevier; 1987. p. 33\u201340."},{"key":"179_CR19","first-page":"545","volume-title":"Les Maladies Systemiques. 3","author":"MF Kahn","year":"1991","unstructured":"Kahn MF, Appeboom T. Syndrome de Sharp. In: Kahn MF, Peltier AP, Meyer O, Piette JC, editors. Les Maladies Systemiques. 3. Paris: Flammarion; 1991. p. 545\u201356."},{"issue":"3","key":"179_CR20","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.rdc.2005.04.002","volume":"31","author":"RJ Mier","year":"2005","unstructured":"Mier RJ, Shishov M, Higgins GC, Rennebohm RM, Wortmann DW, Jerath R, et al. Pediatric-onset mixed connective tissue disease. Rheum Dis Clin N Am. 2005;31(3):483\u201396 vii.","journal-title":"Rheum Dis Clin N Am"},{"issue":"2","key":"179_CR21","doi-asserted-by":"publisher","first-page":"67","DOI":"10.5114\/reum.2016.60215","volume":"54","author":"MM Chojnowski","year":"2016","unstructured":"Chojnowski MM, Felis-Giemza A, Olesinska M. Capillaroscopy - a role in modern rheumatology. Reumatologia. 2016;54(2):67\u201372.","journal-title":"Reumatologia."},{"issue":"2","key":"179_CR22","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/j.berh.2013.03.001","volume":"27","author":"M Cutolo","year":"2013","unstructured":"Cutolo M, Sulli A, Smith V. How to perform and interpret capillaroscopy. Best Pract Res Clin Rheumatol. 2013;27(2):237\u201348.","journal-title":"Best Pract Res Clin Rheumatol"},{"issue":"3","key":"179_CR23","first-page":"328","volume":"16","author":"D Alarcon-Segovia","year":"1989","unstructured":"Alarcon-Segovia D, Cardiel MH. Comparison between 3 diagnostic criteria for mixed connective tissue disease. Study of 593 patients. J Rheumatol. 1989;16(3):328\u201334.","journal-title":"J Rheumatol"},{"issue":"8","key":"179_CR24","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1016\/j.autrev.2011.10.020","volume":"11","author":"N Agmon-Levin","year":"2012","unstructured":"Agmon-Levin N, Mosca M, Petri M, Shoenfeld Y. Systemic lupus erythematosus one disease or many? Autoimmun Rev. 2012;11(8):593\u20135.","journal-title":"Autoimmun Rev"},{"issue":"4","key":"179_CR25","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/j.autrev.2012.09.004","volume":"12","author":"C Tani","year":"2013","unstructured":"Tani C, D'Aniello D, Delle Sedie A, Carli L, Cagnoni M, Possemato N, et al. Rhupus syndrome: assessment of its prevalence and its clinical and instrumental characteristics in a prospective cohort of 103 SLE patients. Autoimmun Rev. 2013;12(4):537\u201341.","journal-title":"Autoimmun Rev"},{"issue":"3","key":"179_CR26","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1002\/art.22003","volume":"55","author":"JA Singh","year":"2006","unstructured":"Singh JA, Solomon DH, Dougados M, Felson D, Hawker G, Katz P, et al. Development of classification and response criteria for rheumatic diseases. Arthritis Rheum. 2006;55(3):348\u201352.","journal-title":"Arthritis Rheum"},{"issue":"10","key":"179_CR27","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1503\/cmaj.091714","volume":"182","author":"MC Brouwers","year":"2010","unstructured":"Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. Development of the AGREE II, part 1: performance, usefulness and areas for improvement. Cmaj. 2010;182(10):1045\u201352.","journal-title":"Cmaj."},{"issue":"4","key":"179_CR28","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1016\/j.semarthrit.2011.07.010","volume":"41","author":"S Cappelli","year":"2012","unstructured":"Cappelli S, Bellando Randone S, Martinovic D, Tamas MM, Pasalic K, Allanore Y, et al. \u201cTo be or not to be,\u201d ten years after: evidence for mixed connective tissue disease as a distinct entity. Semin Arthritis Rheum. 2012;41(4):589\u201398.","journal-title":"Semin Arthritis Rheum"},{"issue":"9","key":"179_CR29","doi-asserted-by":"publisher","first-page":"2595","DOI":"10.1002\/art.27543","volume":"62","author":"AL Herrick","year":"2010","unstructured":"Herrick AL, Cutolo M. Clinical implications from capillaroscopic analysis in patients with Raynaud's phenomenon and systemic sclerosis. Arthritis Rheum. 2010;62(9):2595\u2013604.","journal-title":"Arthritis Rheum"},{"issue":"12","key":"179_CR30","doi-asserted-by":"publisher","first-page":"2087","DOI":"10.1136\/annrheumdis-2013-203716","volume":"73","author":"T Minier","year":"2014","unstructured":"Minier T, Guiducci S, Bellando-Randone S, Bruni C, Lepri G, Czirjak L, et al. Preliminary analysis of the very early diagnosis of systemic sclerosis (VEDOSS) EUSTAR multicentre study: evidence for puffy fingers as a pivotal sign for suspicion of systemic sclerosis. Ann Rheum Dis. 2014;73(12):2087\u201393.","journal-title":"Ann Rheum Dis"},{"issue":"11","key":"179_CR31","doi-asserted-by":"publisher","first-page":"2737","DOI":"10.1002\/art.38098","volume":"65","author":"F van den Hoogen","year":"2013","unstructured":"van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology\/European League against rheumatism collaborative initiative. Arthritis Rheum. 2013;65(11):2737\u201347.","journal-title":"Arthritis Rheum"},{"issue":"1","key":"179_CR32","first-page":"155","volume":"27","author":"M Cutolo","year":"2000","unstructured":"Cutolo M, Sulli A, Pizzorni C, Accardo S. Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol. 2000;27(1):155\u201360.","journal-title":"J Rheumatol"},{"issue":"2","key":"179_CR33","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1002\/art.1780290206","volume":"29","author":"F Granier","year":"1986","unstructured":"Granier F, Vayssairat M, Priollet P, Housset E. Nailfold capillary microscopy in mixed connective tissue disease. Comparison with systemic sclerosis and systemic lupus erythematosus. Arthritis Rheum. 1986;29(2):189\u201395.","journal-title":"Arthritis Rheum"},{"issue":"1","key":"179_CR34","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1080\/17843286.1993.11718282","volume":"48","author":"D Blockmans","year":"1993","unstructured":"Blockmans D, Vermylen J, Bobbaers H. Nailfold capillaroscopy in connective tissue disorders and in Raynaud\u2019s phenomenon. Acta Clin Belg. 1993;48(1):30\u201341.","journal-title":"Acta Clin Belg"},{"issue":"2","key":"179_CR35","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1007\/BF02230332","volume":"15","author":"D Blockmans","year":"1996","unstructured":"Blockmans D, Beyens G, Verhaeghe R. Predictive value of nailfold capillaroscopy in the diagnosis of connective tissue diseases. Clin Rheumatol. 1996;15(2):148\u201353.","journal-title":"Clin Rheumatol"},{"key":"179_CR36","first-page":"738","volume":"75","author":"A Felis-Giemza","year":"2016","unstructured":"Felis-Giemza A, Kontny E, Haladyj E, Nalecz-Janik J, Walkiewicz-Pielaszek K, Czuszynska Z, et al. Early nailfold capillaroscopic pattern predominates in patients with mixed connective tissue disease. Ann Rheum Dis. 2016;75:738.","journal-title":"Ann Rheum Dis"},{"issue":"7","key":"179_CR37","first-page":"1081","volume":"56","author":"IM Markusse","year":"2017","unstructured":"Markusse IM, Meijs J, de Boer B, Bakker JA, Schippers HPC, Schouffoer AA, et al. Predicting cardiopulmonary involvement in patients with systemic sclerosis: complementary value of nailfold videocapillaroscopy patterns and disease-specific autoantibodies. Rheumatology (Oxford). 2017;56(7):1081\u20138.","journal-title":"Rheumatology (Oxford)"},{"issue":"7","key":"179_CR38","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.3899\/jrheum.121272","volume":"40","author":"A Hajas","year":"2013","unstructured":"Hajas A, Szodoray P, Nakken B, Gaal J, Zold E, Laczik R, et al. Clinical course, prognosis, and causes of death in mixed connective tissue disease. J Rheumatol. 2013;40(7):1134\u201342.","journal-title":"J Rheumatol"},{"issue":"10","key":"179_CR39","doi-asserted-by":"publisher","first-page":"3039","DOI":"10.1007\/s00296-011-2109-2","volume":"32","author":"S Pavlov-Dolijanovic","year":"2012","unstructured":"Pavlov-Dolijanovic S, Damjanov NS, Stojanovic RM, Vujasinovic Stupar NZ, Stanisavljevic DM. Scleroderma pattern of nailfold capillary changes as predictive value for the development of a connective tissue disease: a follow-up study of 3,029 patients with primary Raynaud's phenomenon. Rheumatol Int. 2012;32(10):3039\u201345.","journal-title":"Rheumatol Int"},{"key":"179_CR40","doi-asserted-by":"crossref","unstructured":"Celinska-Lowenhoff M, Pastuszczak M, Pelka K, Stec-Polak M, Wojas-Pelc A, Musial J. Associations between nailfold capillaroscopy findings and interstitial lung disease in patients with mixed connective tissue disease. Arch Med Sci. 2019; (in press).","DOI":"10.5114\/aoms.2018.81129"},{"issue":"1","key":"179_CR41","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1136\/annrheumdis-2016-209522","volume":"76","author":"SO Hetlevik","year":"2017","unstructured":"Hetlevik SO, Flato B, Rygg M, Nordal EB, Brunborg C, Hetland H, et al. Long-term outcome in juvenile-onset mixed connective tissue disease: a nationwide Norwegian study. Ann Rheum Dis. 2017;76(1):159\u201365.","journal-title":"Ann Rheum Dis"},{"issue":"1","key":"179_CR42","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1007\/s10067-009-1276-y","volume":"29","author":"YY Tsai","year":"2010","unstructured":"Tsai YY, Yang YH, Yu HH, Wang LC, Lee JH, Chiang BL. Fifteen-year experience of pediatric-onset mixed connective tissue disease. Clin Rheumatol. 2010;29(1):53\u20138.","journal-title":"Clin Rheumatol"},{"issue":"3","key":"179_CR43","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.jbspin.2015.05.013","volume":"83","author":"S Tellier","year":"2016","unstructured":"Tellier S, Bader-Meunier B, Quartier P, Belot A, Deslandre C, Kone-Paut I, et al. Initial presentation and outcome of pediatric-onset mixed connective tissue disease: a French multicenter retrospective study. Joint Bone Spine. 2016;83(3):369\u201371.","journal-title":"Joint Bone Spine"},{"issue":"4","key":"179_CR44","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1177\/0961203307076517","volume":"16","author":"A de Holanda Mafaldo Diogenes","year":"2007","unstructured":"de Holanda Mafaldo Diogenes A, Bonfa E, Fuller R, Correia Caleiro MT. Capillaroscopy is a dynamic process in mixed connective tissue disease. Lupus. 2007;16(4):254\u20138.","journal-title":"Lupus."}],"container-title":["BMC Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s41927-021-00179-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s41927-021-00179-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s41927-021-00179-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T00:16:02Z","timestamp":1616112962000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcrheumatol.biomedcentral.com\/articles\/10.1186\/s41927-021-00179-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,19]]},"references-count":44,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["179"],"URL":"https:\/\/doi.org\/10.1186\/s41927-021-00179-2","relation":{},"ISSN":["2520-1026"],"issn-type":[{"value":"2520-1026","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,19]]},"assertion":[{"value":"21 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The University of Utah Institutional Review Board does not require review of case reports which do not meet the definition of human subject research. All authors have read and agreed to the statement of assurance. Documentation available upon request.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The University of Utah Institutional Review Board does not require review of case reports which do not meet the definition of human subject research. All authors have read and agreed to the statement of assurance. Documentation available upon request. Written informed consent was obtained from the patient\u2019s parent\/guardian for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"9"}}